NPIMap

Individual provider Active NPI

Jocelyn Nichole Spoon, M.D.

  • Cardiovascular Disease Physician
  • Missoula, MT
National Provider Identifier
1548427644
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
53479 Issued in MN
Practice address
500 W Broadway St
Suite 320
Missoula, MT 59802-4008
Phone
(406) 329-5615
Fax
(406) 329-2791
NPI assigned
May 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 104945 MN
Cardiovascular Disease Physician 207RC0000X 53479 MN Primary
Internal Medicine Physician 207R00000X 125053081 IL

Addresses

Primary practice location

500 W Broadway St
Suite 320
Missoula, MT 59802-4008

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (406) 327-1918

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jspoon304747@wm.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140815001090 MT Practitioner - Cardiovascular Disease (Cardiology) 6103958343 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Rush Medical College of Rush University, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Suite 320
Missoula, MT 59802-4003
Phone (406) 329-5615

Hospital & facility affiliations

  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Providence St Joseph Medical Center Hospital, Polson, MT, CCN 271343
  • Barrett Hospital & Healthcare Hospital, Dillon, MT, CCN 271318
  • Clark Fork Valley Hospital Hospital, Plains, MT, CCN 271323
  • Steele Memorial Medical Center Hospital, Salmon, ID, CCN 131305

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125053081ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Internal Medicine CurrentSince Sep 1, 2014 Accepting new patients
Providence St Joseph Medical Center CurrentSince Oct 29, 2018 Accepting new patients
Providence Health & Services Mt Current Accepting new patients
Credena Health LLC CurrentSince Oct 29, 2018 Accepting new patients
Providence Health & Services Mt CurrentSince Sep 1, 2014 Accepting new patients

Locations

2829 Great Northern Loop
Ste 300
Missoula, MT 59808
Phone (406) 541-7000

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377

Interoperability endpoints

  • Direct secure messaging: jspoon304747@wm.providencedirect.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1548427644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "406-327-1918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "address_2": "SUITE 320",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-329-5615",
            "fax_number": "406-329-2791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPOON",
        "first_name": "JOCELYN",
        "middle_name": "NICHOLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-18",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "104945",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "53479",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125053081",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jspoon304747@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "500 W Broadway St",
            "address_2": "suite 320",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.